JMIR Publications

ABSTRACT

Background:

Apps targeting health behaviors (mHealth apps) using behavior change techniques (BCTs) have been successful in promoting healthy behaviors, yet their efficacy with sleep is unclear. Some work has shown success in promoting sleep through mHealth whereas there have been reports sleep apps can be adverse and lead to unhealthy obsessions with achieving perfect sleep. This study systematically reviewed peer-reviewed studies that utilized BCTs within an mHealth app to improve sleep.

Objective:

We aimed to report and describe the use of BCTs in mHealth apps for sleep with the following research questions: (1) How many BCTs are used on average in sleep apps and does this relate to their effectiveness on sleep outcomes? (2) Are there specific BCTs used more or less often in sleep apps and does this relate to their effectiveness on sleep outcomes? (3) Does the effect of mHealth app interventions on sleep change when distinguishing between dimension and measurement of sleep?

Methods:

A systematic review following PRISMA guidelines reviewed articles on mHealth app interventions for sleep published between 2010 and 2020.

Results:

Twelve studies met eligibility criteria. Most studies reported positive sleep outcomes, and there were no negative effects reported. Sleep quality was the most common dimension of sleep targeted. Subjective measures of sleep were used across all apps, while objective measures were used but rarely reported. The average number of BCTs used was 7.64 of 16. The most commonly used BCTs were Feedback & monitoring (92%), Shaping knowledge (92%), Goals & planning (83%), and Antecedents (83%), while the least common were Scheduled consequences (0%), Self-belief (0%), and Covert learning (0%). Most apps used a similar set of BCTs that unfortunately did not allow us to distinguish which BCTs were present when studies reported more positive outcomes.

Conclusions:

Our study describes the peer-reviewed literature on sleep apps, and provides a foundation for further examination and optimization of BCT use in mHealth apps for sleep. More research is needed to understand how BCTs can be implemented effectively to improve sleep using mHealth, and the mechanisms of action through which they are effective (e.g., self-efficacy, social norms, attitudes, etc.). Future research should examine role of sleep hygiene as a precursor to sleep improvement, the utility of targeting multiple health behaviors with sleep, and individual BCT efficacy through optimization trials.